To: info@DoctorHerb.co.uk

From
Name:		
Postal Address:	
Email:		

	Kava Kava Statement agreement.

I confirm that I have researched the possible medical side effects of Kava Kava (in particular with regards to those people with liver problems) to my own satisfaction and that I still wish to order Kava Kava through Doctor Herb .co.uk.

I warrant not to sue, seek recompense, or hold liable, Doctor Herb or any of its agents for any reason connected with its supply of Kava Kava to me. I indemnify Doctor Herb and its agents against any such claims which exceed the cost of the original herb purchase.

I have read and understood Doctor Herb's advice about sticking to the suggested dosage of one tablet per day for 14 days and leaving at least a 7 day break before reviewing taking another course.

If I have any concerns or develop any symptoms I will stop taking the herb and consult my doctor immediately.

I confirm that I will not be irresponsible and allow this herb to be taken by minors, or any other party, especially those with medical conditions or pregnancy.

I confirm that I do not currently have a liver condition.

I confirm that I am not currently pregnant or breast feeding.

This agreement is made under the jurisdiction and laws of England.

Agreed and confirmed by;


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Dated this day the 
? - ? - 2003